Archive for April, 2012

A March 27, 2012, Wall Street Journal article, “This Season’s Ticking Bomb,”predicted that the unusually warm weather most of the country has been experiencing meant we would also see many more cases of tick-borne diseases, If you click on the link, be sure to look at the section called “View Interactive” to get to a series of suggestions on reducing your family’s risk of tick bites.

The article itself talked mainly about Lyme disease. There is an International Lyme and Associated Diseases Society (ILADS), but much of their Lyme disease website information was from 2006. They are on one side of a major medical controversy, how to care for patients who have had Lyme disease and continue to have problems, especially with short-term memory, fatigue, or musculoskeletal issues, well after they have been appropriately treated with short-term antibiotics.

The real question is whether the bacteria involved, Borrelia burgdorferi, remains in the body of a patient after relatively short-term antibiotic therapy and if a considerably longer course of drug treatment is warranted. The ILADS says, “Yes” to both questions and refers back to a Harvard & Tufts study published in the Annals of Internal Medicine in 1994.

The most recent CDC online information states that 10 to 20% of those who receive standard therapy for Lyme disease will have some lingering symptoms. However they term this “Post-treatment Lyme disease Syndrome.” I found that European cases of Lyme and similar diseases are usually caused by our Borrelia borgdorferi’s cousins; data from that literature may not be relevant here.

In November 2006, the Attorney General of Connecticut (CAG) pushed the Infectious Disease Society of America (IDSA) into a detailed review of their Lyme Disease guidelines by starting an investigation to decide if they had violated existing antitrust laws. By April 2008, the IDSA and the CAG agreed to end the probe by convening a review panel, with members from Duke, the NIH, Dartmouth, the U.S. Navy, Baylor, Tulane and other centers, to decide if the original guidelines had been based on sound medical/scientific evidence and if they needed changes. An MD, PhD medical ethicist screened panel members for any conflict of interest. A public hearing was held to include other viewpoints. The Final Report of the Review Panel was published in April, 2010.

Some will think the decision ties their doc's hands.

It basically upheld the 2006 IDSA guidelines, but added 1). In some cases (non-pregnant adults or kids 8 or older who’ve had a tick of the Lyme-carrying species attached for 36+ hours in an area with high infectivity rate of ticks with B. burgdorferi), a single dose of doxycycline (if they have no allergy to this drug) may be given if the tick was removed within 72 hours; 2). Antibiotics are appropriate for adults and children 8 or older with early, uncomplicated Lyme disease; 3). “Reports purporting to show the persistence of viable B. burgdorferi organisms after treatment with recommended regimens for Lyme disease have not been conclusive or corroborated by controlled studies.” and 4). “The risk/benefit ratio from prolonged antibiotic therapy strongly discourages prolonged antibiotic courses for Lyme disease.

And at the end of the report, they mentioned a disease I’d never heard of; I’ll do some more reading and write about it later.

I’m finally ready to write about Lyme disease and will start with the basics; it results from the bite of a tiny tick and causes well over 20,000 cases per year in the US. It’s most common in the North-East and the Middle-West, most frequently affects kids under 16 (especially girls–ticks can hide in long hair) and can be prevented (DEET to keep ticks away; post-hike “tick checks”); prompt antibiotic treatment is indicated if signs or symptoms/history suggest this entity.

you have to look closely

I’ll save the controversy about post-treatment Lyme disease syndrome, AKA Chronic Lyme Disease, for another post as that issue deserves its own discussion.

We first heard about Lyme disease some years back when a relative was afflicted by a severe case of the illness. One of the best resources I’ve subsequently found on Lyme came from an emeritus at the place I got my formal medical training, the University of Wisconsin, now termed UW-Madison. Dr. Kenneth Todar, a PhD in the Department of Bacteriology, has a superb online textbook and his chapter on Lyme Disease is an extremely helpful reference.

The initial realization of the disease itself happened thirty-seven years ago. The website for NIAID, the National Institute of Allergy and Infectious Diseases has a great, though somewhat convoluted, detailed history of Dr. Willy Burgorfer’s isolation of the spirochete bacteria that would eventually be named for him.

In brief, there had been a 1975 outbreak that resulted in a considerable number of children living in or near the town of Lyme, Connecticut, being diagnosed with juvenile rheumatoid arthritis. The Yale physician looking for the cause of these Lyme disease cases realized most occurred in children who spent time in wooded areas and whose initial symptoms occurred in the midst of the tick season, summer. He thought the deer tick might be involved and, eventually, Dr. Burgdorfer found the spirochetes in deer ticks sent to him from the affected area.

To reiterate the concepts I think are crucial: the groups involved, kids under 16 with more girls than boys, plus adult men;. the areas of the country: 93% of cases occur in ten states: Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island and Wisconsin; the fact that early diagnosis is clinical (antibodies develop later); the tiny size (two mm) of the tick nymphs which usually are the agents for transmission of the bacteria; the difficulty in diagnosis unless the characteristic rash is present; and the need for prompt antibiotic treatment in prevention.

Symptoms begin to show anywhere from a few days to a month after the bite, but, in most cases, the tick itself has to remain attached for a day and a half to transmit the bacteria and there is no person to person spread of this disease. Early signs, in the absence of the characteristic rash, are very non-specific.

There is a sizable percentage of patents with Lyme who have long-term sequelae. I’ll write about them next time.

I had almost finished my post on Colorado tick-borne diseases when I noticed an entity I was unfamiliar with, Tick paralysis. The CDC’s comment on this says it’s a “loss of muscle function that results from a tick bite.” But as I read other websites, it’s also the only tick-borne disease that’s not caused by an infectious organism, e.g., a bacteria or a virus. Female, egg-laden ticks produce a neurotoxin, a substance poisonous to the normal function of the nervous system.

Typically children under 16, more girls than boys, are affected, and may develop an acceding paralysis, with leg weakness that can rise to the truck within a few hours and potentially cause death.

But if the tick, mostly found on the scalp, is removed, the symptoms usually resolve rapidly.

This particular chemical or mix of chemicals (it’s never been identified), is junior league compared to some of its cousins.

choose your sushi chef wisely

The other neurotoxins you may have heard about much more potent. Fugu poisoning caused by eating a puffer fish/blow fish, was apparently found over 3,000 years ago in ancient Egypt and documented in the 1800s by Captain Cook’s journals of exploration. US cases are rare and the fish in question is found off Florida’s coast, the Gulf of Mexico and Baja California. But restaurants in Japan and Korea have served it as a delicacy for thousands of years. The chefs who do so go through rigorous training and have to pass both written and hands-on exams before they earn the license to prepare it in a restaurant.

The fish itself can only be offered in grocery store with a permit and, since the toxin, a thousand times as potent as cyanide, is mostly found in the skin, ovaries and liver of the fish, selling them whole is forbidden. There’s a great 2009 New York Times article on eating fugu here. I’m not about to try it myself.

It started as a way to catch dinner

And then there’s curare, the poison applied to darts in South America which caused paralysis of the muscles used in breathing. It was basically used in hunting as the preparation of this toxic brew (the name actually has been used for a number of substance, mostly made from a poisonous bark) was too laborious for it to be used in fighting other tribes. Eating the flesh of birds or mammals killed by this highly potent mixture has no toxic effect on humans. I’m unaware of any history of hunting using blowguns with curare-tipped darts in the US; instead curare was used medically, initially in mitigating the seizures that resulted from shock therapy, later in keeping patents immobilized during some surgical procedures. Other drugs eventually were developed to replace it.

Tick paralysis affects cows and sheep, killing thousands, in other segments of the globe. Human cases in the US cases are uncommon and mostly occur in children under 16. Once the tick is removed the symptoms normally go away rapidly, but rarely severe paralysis can develop before the tick is found and lead to death, Most commonly the tick is embedded in the scalp and two to seven days after it feeds, the child develops weakness in both legs. If nothg is done, the weakness can progress upward and eventually lead to respiratory failure.

Another initial sign of this disease is ataxia, defined on a Mayo Clinic website as a “Lack of muscle coordination during voluntary movements.” Tick bites can cause this syndrome without obvious muscle weakness, so be alert if your kids

The Wall Street Journal recently published an article titled “This Season’s Ticking Bomb,” discussing the rise of tick-borne diseases, especially focusing on Lyme disease. It said two factors have been important contributors to this global trend: people have moved into turf harboring animal species which often carry ticks and, simultaneously, some kinds of those animals, e.g., squirrels, deer and mice, have increased their numbers.

I must confess I haven’t worried much about Lyme disease since our 1999 move to Fort Collins, Colorado, where our back porch is at an altitude of 5,206 feet. Then I found an online 2012 fact sheet from Colorado State University; its subject, “Colorado Ticks and Tick-borne Diseases” gave me pause until I read, “No human cases of Lyme disease have originated in Colorado.”

I was amazed to find that ticks here are especially common at higher altitudes; I would have guessed the opposite was true.

We have two species of Colorado ticks that are most relevant to humans: the American dog tick and the Rocky Mountain wood tick. They are three-host blood-feeding parasites, moving from rodents or other small mammals to dogs or deer typically and then, when available, on to human hosts. We’re more likely to encounter them in spring or early summer on paths through grassy areas or the brushy zones near the edges of field and woods.

I initially was concerned about the risk of Rocky Mountain spotted fever (RMSF), but it’s actually fairly rare here and most common in North Carolina, Oklahoma, Arkansas, Tennessee and Mississippi. From 2,000 to 2,500 cases occur a year in the US with those five states accounting for 60%. They see 19 to 77 cases a year per million while Colorado has 0.2 to 1.5 cases per million. The CDC webpage on RMSF notes the overall incidence of the disease has gone up considerably since 1920, but the fatality rate has plummeted. But in eastern Arizona, through 2009, over 90 cases were noted in a previously RMSF-free area. Ten percent of those who developed RMSF died and there was a marked association with communities with free-roaming dogs.

Colorado Tick fever is seen more frequently in my state than any other infection related to tick bites. It’s a viral disease with up to 15% of our campers being exposed, but is not as serious as many other tick-bite-caused illnesses. It usually goes away without causing complications, but 5-10% of those infected with the virus can develop encephalitis, meningitis or, rarely, hemorrhagic fever. Children are more prone to severe acute disease and more likely to have the nervous system complications, but most kids who contract this illness get well quickly. About 70% of adults over 30 may have prolonged symptoms.

make your body a no-tick zone

Half of those who develop Colorado tick fever have a so-called “saddle-back” temperature curve with initial fever then normal temperature followed by a single fever recurrence.

I’m in the prime zone for this disease; it normally occurs in those living or traveling to altitudes of 4,000 to 10,000 feet. So it’s important for me and others living or visiting here to wear protective clothing, use DEET as a tick repellent, do a “tick check” after a day outdoors and, if any are found to remove them properly with blunt tweezers.

We got an older dog, a thirty-pound Tibetan terrier, eight months ago after not having a pet in the home for three years. He’s had all his immunizations, but he’s due for a repeat rabies shot in June. We plan to travel via car with him for the month of October and want to cross the Canadian border to see Vancouver. So we asked friends who have two much larger dogs and live in Washington State if they’ve been able to take their dogs into Canada.

“It’s no problem as long as you bring proof that his rabies vaccination is current,” my friend Bob said.

We joined the Rocky Mountain Tibetan Terrier Association and got their newsletter. One section was on preventing dog attacks, both outside the home and at home. The information came from the American Veterinary Association. More than 60% of dog bite victims are children; they need to learn not to play rough with family pets. One comment said, “Never put your face directly in front of a dog–even in play.”

‘Guilty as charged,’ I thought. Yoda and I play and he often licks my face. I don’t plan to change my behavior, but I will mention the ideas to the parents of his favorite kid, who is now one and a half years old. I do think the recommendation makes sense, for children in particular.

bats may carry the disease

So why is this important? I found an NIH National Library of Medicine article on rabies which said that deadly viral infection is spread by infected animals. In the US the number of cases has fallen dramatically and most bites from rabid animals involve non-canines: bats, raccoons, foxes and skunks as well as cats are mentioned. We spend over $300 million a year on rabies prevention with the vast majority of that going to pet immunizations.

Worldwide rabies statistics are quite different: over 90% of human exposure to rabies and over 99% of deaths are due to rabid dogs. Many developing countries, in spite of some having programs to vaccinate dogs and get rid of strays, can’t afford a complete program.

If your child or anyone else is bitten by a non-vaccinated animal, then immediate medical care is absolutely crucial. The CDC has an online helpful description of appropriate wound care and rabies post-exposure vaccinations. Let’s be clear: if your child or you are bitten, even by a beloved pet of yours that has had its shots, see your doctor right then or go to an ER. Animal bites can cause many complications outside of rabies.

Why is this so important? Well, I just read an article about a survivor from clinical rabies, an eight-year-old girl from a non-urban area on the West Coast. That’s exceedingly rare!

Yes, that’s true; rabies is uniformly fatal…unless it’s prevented. In the US, there have been only three people who got rabies and survived. So urgent treatment with a series of shots of both human rabies immune globulin and rabies vaccine is critical.

In my last post, about trying to decrease the incredible expense of US health care, I gave a link to the ideas Dr. Donald Berwick had outlined in the April 11th edition of JAMA. He thinks we could save huge amounts in six areas: failure of care delivery; failure of care coordination; overtreatment; administrative complexity; pricing failures and fraud & abuse.

Now I’d like to look at a few specific examples.

The same JAMA edition had a research article titled “Association of Major and Minor ECG Abnormalities with Coronary Heart Disease Events” It detailed the followup of nearly 2,200 people in my age range and up (they were 70 to 79) who were in the Health, Aging and Body Composition Study. Thirteen percent had electrocardiograms with minor changes when the study started; twenty-three percent had more significant changes. Both kinds of ECG changes were associated with an increased likelihood of having coronary artery disease (CHD) during the subsequent years.

Now ECGs are relatively cheap and can be done in many settings. But the senior author, Dr. Reto Auer, said in an interview for a publication called heartwire “Our data do not permit one to say anything about clinical practice.” The article itself concluded, “Whether ECG should be incorporated in routine screening of older adults should be evaluated in randomized, controlled trials.”

In the same edition of JAMA a Northwestern University Preventive Medicine professor, Dr. Philip Greenland, commenting on Auer’s research, mentioned a 1989 summary of the value of the “resting ECG,” which said additional study was needed. Dr.Greenland said the major finding in Auer’s work was a relatively new measurement called the net reclassification index (NRI). As opposed to diagnostic studies (e.g., does this patient have heart disease), this study hoped to be prognostic, telling what the chances were of a major heart event occurring in the future to a particular study subject. In this case the NRI helped most in reclassifying people into a lower CHD risk group, not a higher one.

All of that is fascinating and the Auer article is a superb example of carefully performed research. But, my fear is that many physicians won’t read the caveats. If you ignore the last paragraph, skip the editorial and never get to “theheart.org’s” take on the work, you may well decide that every older adult should have an ECG done on a regular basis.

What should we do if your cholesterol is high?

In the same edition of the journal is a pair of short articles deliberately set up to examine a medical controversy, in this case whether a middle-aged man with an elevated cholesterol, but no personal or family history of coronary heart disease should be given statin drugs to lower his cholesterol. This is a new feature of the journal, and the accompanying editorial, with the intriguing title, “The Debut of Dueling Viewpoints,” explains this will be a continuing series of discussions and debates.

What a wonderful idea.

The the online publication, theheart.org actually had a nice summary of the two pieces,

Whenever I think of medical waste I flash back to the episode (It’s in one of my old blog posts) with my Radiation Safety Officer standing on a pile of garbage in a municipal dump in Biloxi, MS, holding a Coke bottle that set off a radiation detector. It had tobacco juice spat by a patient who’d had a thyroid scan.

But that’s not what I’m writing about today.

There’s a great article in the most recent edition of JAMA with the title “Eliminating Waste in US Health Care.” In July, 2010, Dr. Donald Berwick, the lead author, was appointed by President Obama to serve as the Administrator of the Centers for Medicare and Medicaid Services. This was a “recess appointment” of a Harvard Medical School professor of pediatrics with a Master of Public Policy degree who had previously led the non-profit Institute for Healthcare Improvement. Congress did not confirm Berwick (ah, politics, isn’t it wonderful) and he left the position in December, 2011.

Berwick and a colleague at the RAND Corporation. a non-profit with goals of improving both decision-making and public policy by utilizing research and analysis, start by stating our health care costs are frankly not sustainable and yet are growing with 2020 estimates of 20% of our gross domestic product (GDP).

Between 1980 and 2008, our US health care costs, as a share of GDP grew phenomenally. The Kaiser Foundation has an online comparison of health care expenditures in the US and 14 other OECD countries. We not only spend more on health care, our per person growth rate of this expenditure is among the highest in the developed world. Let’s put that into concrete terms. The Kaiser paper shows a graph of total health care spending per person versus gross domestic product per person and locates where 15 of the world’s developed countries fall in comparing those two variables.

The dots representing thirteen of the countries form a line with Italy having the last spending and the least average “income” per person and Switzerland having the top amounts of that group in both categories. Then there’s Norway and the United States, both well off the line. The average Norwegian income is considerably higher than the US average, but the average amount spend on all their health care is way below the line, while ours is far above that same line.

These were 2008 figures, but the major difference was shown in growth of the total spent on health care per person per year and the source of that money. In Norway’s case, the bulk is public spending and in ours it is split between public and private. And our growth in both categories tops the pack.

It's time to look at all the ways to solve the puzzle

Dr. Berkwick’s article in JAMA details how much we could potentially save with six strategies to reduce “medical waste.” The total is staggering: $3 trillion in Medicare and Medicaid savings and $11 trillion overall by 2020. He contrasts this to the savings proposed in the Affordable Healthcare Act of $670 billion between 2011 and 2019, no paltry sum by any means, but dwarfed by the common sense proposals he makes.

I’ve just read an article in The Wall Street Journal about the Tennessee governor being ready to sign a new bill proposed by a Knoxville legislator. If signed, the new law would require public schools to allow their science teachers to discuss alternate explanations of evolution and global warming. In theory this would protect those teachers who already wish to teach, for instance, intelligent design; in reality it would compel some of those who don’t consider these concepts as valid to discuss them anyway.

Tennessee wouldn’t be the first state to pass such legislation: Louisiana and Mississippi recently did so and seven other states at least allow such contrary theories to be taught to public school students. The American Association for the Advancement of Science and local members of the national Academy of Science are against the new bill. One state education official accused legislators of trying to “micromanage curriculum.”

Much of the impetus for the bill and similar proposals in other states comes from Focus on the Family, a conservative group in Colorado and the actual wording follows that espoused by the Seattle based Discovery Institute. Tennessee has a eighty-six-year history of conflict between science and religion with the John Scopes 1925 trial being an important historical vignette in this conflict. A Dayton, Tennessee, high school teacher was fined $100 for daring to teach evolution in a public school. William Jennings Bryan, former US presidential candidate, then the state’s attorney and a Bible literalist, arguing the case versus Scopes while Clarence Darrow defended the educator.

In 1650 Bishop Ussher, the famous Irish prelate, had said, firmly, that the world was created in 4004 B.C. His methodology, if not his results, has been praised by paleontologist Stephen Jay Gould. Ussher had added the ages of twenty-one generations noted in the Hebrew Bible, researched Ptolemy’s list of the kings of Babylon to pinpoint the time of the destruction of the First Temple and then tied dates in Greek history to the modern Julian calendar. His precise dating of Creation, however, was based on a portion of the Book of Genesis in which the fruit in the Garden of Eden is ripe, implying, to Ussher, Autumn.

The trial transcript is fascinating as Darrow questions Bryan about the six days of Creation and Bryan replies, “I do not think they were twenty-four-hour days.” This eventually led to a split in the Fundamentalist community between Biblical literalists and those who favor the days as metaphors, but strongly argue humans were designed by God, not evolution.

The concept of intelligent design is the modern counterpart of Ussher’s dating of Creation. It’s of interest that in 2001 at least one of the current presidential candidates, as a US Senator, added an amendment to the No Child Left Behind Act which would include discussion in the classroom of possible controversies over evolution. The Santorum Amendment was approved by a heavy majority of both political parties.

We each have our own thoughts on how to reach Heaven

I’m currently a co-president of our congregation and have my own solid religious beliefs, but I also trained in medicine and learned to look at the data. It appears to me that intelligent design is a somewhat vaguely worded religious concept, not a scientific theory and I haven”t seen evidence to support it. When last I knew most scientists don’t agree with it. And we still have a principle of separating Church and State.

I’ve been skeptical about many of the claims made for herbal medicines, as they’re often based on case reports or other empirical data and seldom seen to meet the rigorous standards I’m used to for new medical findings. Yet millions of people over the last four thousand years have used Oriental medicine mixtures and some of those are now being subjected to intense study.

The NIH’s National Center for Complementary and Alternative Medicine has a website that provides useful links into this complex and sometimes baffling field. A 2007 survey showed 38% of Americans use CAM, often in the form of dietary supplements, where well-designed clinical trials may be lacking and the safety and effectiveness of the CAM therapy is unclear.

I want to focus on one of these CAM therapies that has been examined in detail and looks exceedingly promising…thus far.

The research of Yung-Chi Cheng, the Henry Bronson Professor of Pharmacology at the Yale School of Medicine, was highlighted in The Wall Street Journal in an article titled, “Chinese Medicine Goes Under the Microscope.” He was raised in Taiwan, but his PhD is from Brown University. Now he directs Yale’s Therapeutics/Chemotherapy Program and has published ground-breaking work in major research journals.

Dr.Cheng has been studying a traditional Chinese medicine for 12 years. Many of China’s 75,000 therapeutic concoctions may seem strange to us, consist of various combinations of 5,000 different plants and have never been tested for efficacy in a fashion we would expect. On the other hand many of our accepted medicines originally came from botanical products. Professor Cheng decided to bridge the gap, studying one particular ancient herbal drug using modern Western methods. Initially he was met with skepticism; his colleagues were concerned that he’d find a lack of consistency in the herbal preparation. Since then Yale sponsored a biotechnology company to ensure uniformity in the plants used to produce the herbal mixture known in the Orient as huang qin tang. Here, as PHY906, it is used with traditional chemotherapy to reduce side effects.

This is a mixture of four different herbs, the flowers of the Chinese skullcap plant, the fruit of the Chinese date tree, Chinese Licorice and Chinese peonies. It’s a complex melange, with 62 active chemicals that apparently must be used together, a form of polypharmacy (several drugs being given at the same time). Thus far animal experiments, reported in two scientific journals, BMC Medical Genomics and Scientific Translational Medicine have been very promising ( a conclusion in the former notes it can decrease toxicity in normal cells while promoting tumor cell death) and human Phase II studies are beginning (Phase I clinical trials are small studies looking at safety, Phase II examine efficacy, does the new drug do what its supposed to; Phase III are considerably larger and compare a drug to existing or standard treatments).

In 2003 Professor Cheng went on to establish the Consortium for Globalization of Chinese Medicine which he now chairs. Aims of the international group include using modern methods to ensure quality control of herbals and coordinating clinical trials in disparate areas of the world.

The target is colon cancer

His work was published online in the journal Nature in a 2010 article, “How an 1,800-year-old herbal mix heals the gut.” In 2011 he received a $6.7M grant from the National Cancer Institute for his project titled, “Chinese Herbal Medicine as a Novel Paradigm for Cancer Chemotherapy.”

I wanted to examine the possible health benefits of chocolate further and found myself immersed in nutritional and biochemical articles. So now I’ve slogged though eight different sources, ranging from a University of Mumbai review of health benefits of some of the chemicals in chocolate (and green tea, onions, red wine and apples) to three nutrition journals, a WebMD piece on antioxidants and a Harvard School of Public Health article titled, “Antioxidants: Beyond the Hype.”

There’s a concept known as the French paradox, first popularized in a 1991 segment on CBS’s show, “Sixty Minutes.” The French eat chocolate and cheeses and drink red wine, yet their obesity rate is the lowest in Europe, and although they smoke and eat a moderately high-fat diet their cardiovascular death is also fairly low. Those statistics are worsening as the invasion of the Western Diet spreads through the country, but they still hold true.

Let’s concentrate on chocolate for now and I’ll return to that paradox some other time

In simplest terms I think of atoms as being like tiny solar systems with a sun (the nucleus) in the middle and “planets,” electrons circling around. The center has relatively large particles with no charge (neutrons) and positive electrical charges (protons); the shells have tiny particles with negative charges (electrons). The latter are not just arranged in orbits like planets; a closer analogy would be Russian Nesting Dolls.

When you eat, your body uses glucose for fuel. In doing so it produces some extremely harmful molecules called free radicals. These are atoms with an electron missing and they try to regain electrical balance by stealing negatively charged particles from other atoms. You can also pick up free radicals from air, food or sunlight’s effect on your skin. They can harm your DNA, cause “bad cholesterol’ to get stuck in the wall of a blood vessel, or speed up the aging process of your skin.

We do have some defences against those nasty free radicals and they’re called antioxidants. A variety of studies done on these chemical weapons have yielded inconclusive results, but one long-term study, part of the Physicians Health Study, appeared to show a significant benefit in cognitive function and another showed a decrease in the risk of heart attacks in men aged 50 or older.

Even these mixed results led to a huge antioxidant supplement industry with sales estimated over $500 million a year.